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Journal of Clinical Microbiology, April 1998, p. 986-989, Vol. 36, No. 4
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.

Soft Salt-Mannitol Agar-Cloxacillin Test: a Highly Specific Bedside Screening Test for Detection of Colonization with Methicillin-Resistant Staphylococcus aureus

Nuria Mir,1 Miguel Sánchez,2 Fernando Baquero,1 Blanca López,2 Celia Calderón,1 and Rafael Cantón1,*

Servicio de Microbiología, Hospital Ramón y Cajal,1 and Unidad de Cuidados Intensivos, Hospital Príncipe de Asturias, Alcalá de Henares,2 Madrid, Spain

Received 15 September 1997/Returned for modification 17 November 1997/Accepted 20 January 1998

The early detection of colonization with methicillin-resistant Staphylococcus aureus (MRSA) of patients in intensive-care units is an essential step in the strategy for preventing MRSA epidemics. In this study, tubes containing soft salt-mannitol agar with cloxacillin (6 µg/ml) (SSMAC) were prepared for inoculation of clinical samples at patients' bedsides by personnel of an intensive-care unit. A total of 1,914 swabs from different sample sites of 81 patients were dipped into SSMAC tubes, and after 24 h of incubation (in an incubator located near the intensive-care unit), an evident color change was considered by the intensive-care-unit personnel to be an MRSA alarm. Sixty-three (3.3%) SSMAC tubes were considered positive for MRSA, 1,827 (95.4%) were considered negative, and 24 (1.2%) were considered intermediate. Compared with values for parallel conventional surveillance cultures for MRSA, excluding tubes with intermediate results, the SSMAC test had a sensitivity of 72.7%, a specificity of 99.2%, a positive predictive value of 76.2%, and a negative predictive value of 99.0%. When intermediate tubes were considered positive, the corresponding values were 75.3, 98.2, 63.2, and 99.0%, respectively. The sensitivity and specificity values of the test to identify MRSA-colonized patients were 89.4 and 100%, respectively. Oropharyngeal and naris specimens were the most reliable samples for MRSA detection. False-negative results were frequent in bronchial aspirates with low (<103 to 106 CFU/ml) MRSA counts. False-positive results were mainly due to methicillin-resistant Staphylococcus haemolyticus. The SSMAC tube is a useful, rapid, and inexpensive tool for the early identification of MRSA-colonized patients and, consequently, for the implementation of measures to prevent the spread of MRSA.

* Corresponding author. Mailing address: Servicio de Microbiología, Hospital Ramón y Cajal, Carretera de Colmenar km 9,1, 28034-Madrid, Spain. Phone: 1-3368330. Fax: 1-3368809. E-mail: rafael.canton{at}hrc.es.

Journal of Clinical Microbiology, April 1998, p. 986-989, Vol. 36, No. 4
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.


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